有占位效应的重型颅脑损伤术后再次手术去骨瓣减压41例分析

目的总结重型颅脑损伤患者因占位性损伤术后再次手术去骨瓣减压的治疗经验。方法回顾性调查2008年1月～2014年10月在四川大学华西医院住院的重型颅脑损伤患者病历,筛查第一次手术清除脑挫裂伤或硬膜下血肿等占位性损伤术后保留骨瓣但再次手术去骨瓣减压的患者,分析再次手术去骨瓣减压原因。结果 41例术后再次手术去骨瓣减压,其中术后局部脑水肿和进展性出血34例,术区新发血肿6例,远隔部位血肿1例。结论有占位效应的重型颅脑损伤患者术后有14.4%的患者再次手术去骨瓣减压,对大多数没有术中脑膨出的患者保留骨瓣是安全的,但对于硬膜下血肿伴脑挫裂伤、伤后早期低血压和初始颅内压35mm Hg的患者可能需要去骨瓣减压。     

重型颅脑火器爆炸伤早期空运医疗后送一例并文献复习

目的探讨重型颅脑火器爆炸伤早期空运医疗后送的可行性。方法报道1例重型颅脑火器爆炸伤术后患者的早期空运医疗后送全流程处置并文献复习。结果本例患者为男性, 20岁, 训练中意外被爆炸手榴弹弹片击中额部, 造成重型颅脑损伤, 急诊行清创及去骨瓣减压术。术后12 h由固定翼飞机经1.5 h航时后送至空军军医大学唐都医院。伤后4个月复查头颅CT示, 去骨瓣减压术后脑室扩张、脑实质多发软化灶形成。结论重型颅脑火器爆炸伤经过空运医疗后送前充分评估及后送中专业的重症管理, 早期空运医疗后送是可行的。     

改良去骨瓣减压术在重型颅脑损伤救治中的应用

目的 评价改良去骨瓣减压术治疗重型颅脑损伤的效果,并比较与标准外伤大骨瓣减压术的疗效差异.方法 将我科2008年1月～2010年6月收治的115例重型颅脑损伤[格拉斯哥昏迷评分(GCS)3～8分]患者随机分为2组,52例采用改良去骨瓣减压术,为改良组;63例采用标准外伤大骨瓣减压术,为标准组.术后治疗方案基本相同,术后...     

术中持续颅内压监测在重型颅脑损伤中的运用研究

目的探讨术中颅内压监测在重型颅脑损伤治疗中的意义。方法收集58例重型颅脑损伤行去骨瓣减压术患者,均予术中颅内压监测,动态记录术前、术中的颅内压情况。术后随访6个月,GOS预后评分4～5为预后良好,1～3分为预后不良。结果术中发生急性脑膨出3例,迟发性颅内血肿4例,其中2例迟发性颅内血肿出现急性脑膨出。全部病例中,出现减压后颅内压反弹升高超过15 mm Hg患者共8例（14.3%）;而7例（87.5%）发生急性脑膨出和迟发性颅内出血的病例均出现减压后颅内压反弹升高超过15 mm Hg。随访6个月,GOS评分不良者占41.4%;而发生术中并发症的患者评分不良者比例高达85.7%（6/7）,且3例死亡均来自发生并发症的患者。结论去骨瓣减压术中发生严重并发症与不良预后相关,术中监测减压后颅内压反弹升高幅度,有助于预防和控制术中并发症的发生,改善患者预后。     

脑室-心房分流术治疗重型颅脑外伤合并脑积水

目的 提高重型颅脑外伤的治疗水平。方法 32例重型颅脑外伤首次行开颅血肿清除,内减压,去骨瓣减压术治疗后,症状改善不明显。术后1－6周内头CT复查证实合并脑积水,颅内压增高,及时行脑室－心房分流术。结果 大部分患者症状均明显改善。GCS较分流前明显提高（P＜0．05）。结论 重型颅脑外伤首次术后,虽经积极治疗,症状无明显改善者,应尽早复查头颅CT,如合并脑积水,尽早行分流手术,以改善神经功能。     

高原地区颅脑损伤去骨瓣减压术后并发症分析

目的 分析高原地区颅脑损伤患者经去骨瓣减压手术治疗后的相关并发症.方法 回顾性分析西藏军区总院2007年6月～2012年6月收治的167例经去骨瓣减压手术治疗的高原地区颅脑损伤患者的病例资料,分析去骨瓣减压手术相关并发症的类型和发生率以及相关临床因素.结果 35例（21.0%）减压术后6个月内死亡.78例（46.7%）发生去骨瓣减压术相关并发症,其中39例（23.4%）出现≥2种并发症.在术后并发症中,脑膨出的发生率最高（26.9%）,其次是硬膜下积液（25.1%）.入院GCS评分低和年龄高与并发症的发生相关.结论 高原地区颅脑损伤去骨瓣减压术最常见的相关并发症为脑膨出和硬膜下积液.术者应考虑GCS评分和年龄等危险因素,预防和采取有效措施防治并发症,改善高原地区颅脑损伤患者预后.     

重型颅脑损伤去骨瓣减压术预后分析

目的分析重型颅脑损伤患者行去骨瓣减压术预后的相关因素。方法对我院于2009年1月~2013年6月收治的110例行单侧或双侧去骨瓣减压术的重型颅脑损伤患者的临床资料进行回顾性分析,其中男性83例,女性27例;年龄14~82岁,平均47.2岁。重点观察年龄、受伤至开颅手术时间、格拉斯哥昏迷评分(GCS)、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间的关系,并将患者6个月以内的扩展的Glasgow预后量表以评分的形式对预后进行评价。结果据单因素法分析结果表明,预后良好组及预后不良组在年龄[(139.08±14.45)岁vs.(53.91±14.65)岁]、受伤至开颅手术时间[(35.64±47.71)h vs.(9.55±12.19)h]、瞳孔大小[(12.85±0.49)mm vs.(3.57±1.01)mm]、GCS评分[6.37±1.56vs.4.55±1.08]及CT值[3.55±0.89 vs.4.48±0.96]方面存在明显差异(P0.05),具统计学意义;据多因素Logistic回归法分析结果表明,年龄、受伤至开颅手术时间、瞳孔大小、GCS评分及CT值与预后之间有密切联系。结论患者年龄、受伤至开颅手术时间、GCS评分、瞳孔大小、对光的反射程度以及CT检查等相关因素与预后之间存在密切联系,可作为对重型颅脑损伤患者预后进行评价的临床指标。     

重型颅脑损伤患者死亡原因分析及应对策略

目的 回顾性研究总结重型颅脑损伤的死亡原因和救治经验。方法分析GCS3～8分的483例重型颅脑损伤病人的伤情、处理措施和预后。结果重型颅脑损伤的死亡率为28％,其中GCS6-8分为15%,3-5分56％,严重脑裂伤、脑肿胀和合并并发症为死亡的主要原因。结论早期诊断、早期处理,有效降低颅内压和防治并发症是降低死亡率的三大主要措施;强调动态CT复查和去骨瓣减压术的重要性。     

标准去大骨瓣减压术治疗重型颅脑损伤临床效果观察

目的探讨标准去大骨瓣减压术治疗重型颅脑损伤的临床效果。方法将2006—2010年中国医科大学附属第一医院鞍山医院收治的50例行常规颞顶瓣开颅术的重型颅脑损伤患者纳入常规骨瓣组,将2014—2018年收治的50例行标准去大骨瓣减压术的重型颅脑损伤患者纳入大骨瓣组。比较两组患者术前和术后第1、3、7天的颅内压,以及术后并发症发生情况;并于术后1个月随访患者生活状态,采用格拉斯哥预后评分评定患者预后。结果常规骨瓣组和大骨瓣组患者术前颅内压比较,差异无统计学意义(P>0.05);大骨瓣组患者术后第1、3、7天的颅内压均低于常规骨瓣组,差异有统计学意义(P<0.05)。大骨瓣组患者术后的脑梗死、切口疝、癫痫发生率均低于常规骨瓣组,差异有统计学意义(P<0.05)。术后随访1个月,大骨瓣组恢复较好患者比例高于常规骨瓣组,死亡患者比例低于常规骨瓣组,差异有统计学意义(P<0.05)。结论标准去大骨瓣减压术是治疗重型颅脑损伤的有效方法,可明显降低患者死亡风险,提高术后生活质量。     

颅骨修补术后感染的相关因素分析

颅骨缺损为神经外科去骨瓣减压术常见的后遗症,多继发于重型颅脑损伤、高血压脑出血、颅内动脉瘤破裂大量出血、大面积脑梗死等需行开颅及去骨瓣减压术术后。为促进患者康复,一般于去骨瓣减压术后数周或数月内行颅骨修补。然而,如修补术后继发感染、或者采用钛网修补出现钛网外露等情况,即宣告该类手术失败,为患者带来更大的痛苦及额外的家庭经济负担。本文对颅骨修补术后感染的相关因素进行分析,并对如何预防术后感染进行讨论。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.